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https://hdl.handle.net/2440/61885
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Type: | Journal article |
Title: | The impact on morbidity and length of stay of early versus delayed complete lymphadenectomy in melanoma: Results of the Multicenter Selective Lymphadenectomy Trial (I) |
Author: | Faries, M. Thompson, J. Cochran, A. Elashoff, R. Glass, E. Mozzillo, N. Nieweg, O. Roses, D. Hoekstra, H. Karakousis, C. Reintgen, D. Coventry, B. Wang, H. Morton, D. |
Citation: | Annals of Surgical Oncology, 2010; 17(12):3324-3329 |
Publisher: | Lippincott Williams & Wilkins |
Issue Date: | 2010 |
ISSN: | 1068-9265 1534-4681 |
Organisation: | MSLT Cooperative Group |
Statement of Responsibility: | Mark B. Faries, John F. Thompson, Alistair Cochran, Robert Elashoff, Edwin C. Glass, Nicola Mozzillo, Omgo E. Nieweg, Daniel F. Roses, Harold J. Hoekstra Constantine P. Karakousis, Douglas S. Reintgen, Brendon J. Coventry, He-Jing Wang, Donald L. Morton, and for the MSLT Cooperative Group |
Abstract: | Background. Complete lymph node dissection, the current standard treatment for nodal metastasis in melanoma, carries the risk of significant morbidity. Clinically apparent nodal tumor is likely to impact both preoperative lymphatic function and extent of soft tissue dissection required to clear the basin. We hypothesized that early dissection would be associated with less morbidity than delayed dissection at the time of clinical recurrence. Materials and Methods. The Multicenter Selective Lymphadenectomy Trial I randomized patients to wide excision of a primary melanoma with or without sentinel lymph node biopsy. Immediate completion lymph node dissection (early CLND) was performed when indicated in the SLN arm, while therapeutic dissection (delayed CLND) was performed at the time of clinical recurrence in the wide excision-alone arm. Acute and chronic morbidities were prospectively monitored. Results. Early CLND was performed in 225 patients, and in the wide excision-alone arm 132 have undergone delayed CLND. The 2 groups were similar for primary tumor features, body mass index, basin location, and demographics except age, which were higher for delayed CLND. The number of nodes evaluated and the number of positive nodes was greater for delayed CLND. There was no significant difference in acute morbidity, but lymphedema was significantly higher in the delayed CLND group (20.4% vs. 12.4%, P = .04). Length of inpatient hospitalization was also longer for delayed CLND. Conclusion. Immediate nodal treatment provides critical prognostic information and a likely therapeutic effect for those patients with nodal involvement. These data show that early CLND is also less likely to result in lymphedema. |
Keywords: | MSLT Cooperative Group Humans Melanoma Skin Neoplasms Lymphatic Metastasis Sentinel Lymph Node Biopsy Prognosis Length of Stay Lymph Node Excision Morbidity Survival Rate Follow-Up Studies Adolescent Adult Aged Middle Aged Female Male Young Adult |
Rights: | (c) Society of Surgical Oncology 2010 |
DOI: | 10.1245/s10434-010-1203-0 |
Published version: | http://dx.doi.org/10.1245/s10434-010-1203-0 |
Appears in Collections: | Aurora harvest 5 Surgery publications |
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